Cultural similarities and differences in medical professionalism: a multi-region study

CONTEXT Over the last two decades, many medical educators have sought to define professionalism. Initial attempts to do so were focused on defining professionalism in a manner that allowed for universal agreement. This quest was later transformed into an effort to 'understand professionalism'as many researchers realised that professionalism is a social construct and is culture- sensitive. The determination of cultural differences in the understanding of professionalism, however, has been subject to very little research, possibly because of the practical difficulties of doing so. In this multi- region study, we illustrate the universal and culture- specific aspects of medical professionalism as it is perceived by medical practitioners. METHODS Forty- six professional attributes were identified by reviewing the literature. A total of 584 medical practitioners, representing the UK, Europe, North America and Asia, participated in a survey in which they indicated the importance of each of these attributes. We determined the 'essentialness' of each attribute in different geographic regions using the content validity index, supplemented with kappa statistics. RESULTS With acceptable levels of consensus, all regional groups identified 29 attributes as ` essential', thereby indicating the universality of these professional attributes, and six attributes as non- essential. The essentialness of the rest varied by regional group. CONCLUSIONS This study has helped to identify regional similarities and dissimilarities in understandings of professionalism, most of which can be explained by cultural differences in line with the theories of cultural dimensions and cultural value. However, certain dissonances among regions may well be attributable to socio- economic factors. Some of the responses appear to be counter- cultural and demonstrate practitioners'keenness to overcome cultural barriers in order to provide better patient care.